Pericarditis Flashcards
What is pericarditis?
Inflammation of the pericardium (membranous sac enclosing heart). Inflamed visceral and parietal layer rub against one another resulting in pain.
*Remember, pericardium is avascular but it does have innervation
State some potential causes of pericarditis- highlight most common
- Idiopathic
- Viral infection e.g. Coxsackie, echovirus, EBV, CMV, adenovirus
- Bacteria e.g. TB
- Autoimmune disease e.g. SLE, sarcoidosis
- Acute MI/Dressler’s syndrome
- Drugs e.g. hydralazine, isoniazid, procainamide, penicillin
- Uraemia
- Trauma, surgery etc..
*
Whats the commonest cause of pericarditis in developing countries?
TB
State the symptoms of pericarditis
- Chest pain
- Sharp
- Retrosternal or left sided
- Worse on leaning back, lying flat, lying on left side, swallowing and/or inspiration
- Better on leaning forwards
- May radiate to left arm/axilla
- Viral prodrome
- Low grade pyrexia
- Malaise
State what you might find on examination of someone with pericarditis?
- Pericardial friction rub heard best over left sternal edge during expiration
- Low grade fever
- Tachycardia
State what investigations you might do for a pt with suspected pericarditis, include:
- Bedside
- Bloods
- Imaging
*For each, justify why
Bedside
- ECG: look for typical features of pericarditis & rule out other causes
Blood tests
- FBC: WCC may be raised
- CRP: may be raised
- Troponin: may be raised
- U&Es: uraemia can be a cause
Imaging
- CXR: may see cardiomegaly (due to pericardial effsuion) on CXR
- ECHO: may reeal pericardial effusion
Describe the ECG changes seen in pericarditis
What is the most specific ECG change in acute pericarditis?
ECG changes:
- Widespread saddle shaped/concave ST elevation
- PR segment depression
PR depression is the MOST SPECIFIC ECG change
Discuss the management of perdicarditis
- NSAIDs or aspirin with gastric protection for 1-2 weeks
- Add colchicine as an adjunct to prevent recurrence for 3 months. NOTE: post-MI pericarditis should be managed with aspirin & colchicine. If give NSAIDs may interfere with healing of myocardium
- Corticosteroids: only be given in connective tissue disease, uraemia or immune mediated pericarditis or if NSAID and colchicine therapy contraindicated or ineffective
State some potential complications of pericarditis- highlight common
- Pericardial effusion
- Cardiac tamponade
- Constrictive pericarditis
Explain the difference between acute post MI pericarditis and Dressler’s syndrome
- Acute post MI: occurs days following MI
- Dressler’s syndrome: occurs months following MI due to immune response
What is constrictive pericarditis?
Progressive thickening, fibrosis and calcification of pericardium which limits the filling of the cardiac chambers.
What % of pts with acute pericarditis may develop constrictive pericarditis?
Around 9%
What is the main cause of constrictive pericarditis in world?
State some other causes
- TB (NOTE: TB not common cause in UK)
Other causes include:
- Cardiac surgery resulting in pericardial truma
- Mediastinal irridation
- Unknown (often the case in the UK)
Describe the typical presentation of constrictive pericarditis
- Presents with features of right sided heart failure
- Raised JVP, Kussmaul sign
- Oedema
- Hepato-splenomegaly
- Ascites
- Dyspnoea and fatigue on exertion due to low cardiac output (as decreased return to left side of heart)
What is Kussmaul sign?
Paradoxical rise in JVP with inspiration
What might you hear when auscultating heart sounds in constrictive pericarditis?
Diastolic pericardial knock
What investigations would you do if you suspect constrictive pericarditis?
- ECHO: may show restrictive mitral filling pattern and pericardial thickening
- CXR: may show pericardial calcification which is pathognomonic of constrictive pericarditis in presence of heart failure and raised JVP
Discuss the management of constrictive pericarditis?
- Definitive treatment= pericardectomy
- Medical therapy for symptoms:
- Diuretics and NSAIDs
- Steroids
- Colchicine
